Pediatric Dentistry · patient case question
The periapical film of the lateral incisor shows enamel and dentin invaginating into the pulp chamber. What is the diagnosis?
Patient case: A young patient in the mixed dentition
demo: 5-year-old female
chief: Routine examination. Her mother is worried that her front teeth are coming through early.
history: Healthy. The family moved recently from a community with fluoridated water to one with none. Her mother reports the older sibling had a similar early pattern.
meds: None.
findings: Both mandibular permanent central incisors are fully erupted. A 3 mm midline diastema is present in the maxilla between the primary central incisors. A periapical film of a maxillary lateral incisor shows an invagination of enamel and dentin extending into the pulp chamber.
Show answer and explanation
Correct answer: A. Dens invaginatus
- A. Correct. Dens invaginatus, also called dens in dente, arises from infolding of the enamel organ before mineralisation. Maxillary lateral incisors are by far the most commonly affected. The invagination gives caries direct access to the pulp, so a tooth can become necrotic while looking clinically intact, which is why prophylactic sealing is advised.
- B. Concrescence is union of two teeth by cementum alone after their roots have formed.
- C. Taurodontism is an elongated pulp chamber with apically displaced furcation, giving the bull-like shape, and involves multirooted teeth.
- D. Dens evaginatus is an outward projection, a tubercle on the occlusal surface of premolars or the cingulum of anteriors, that wears or fractures and exposes a pulp horn.
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